E-6
FITNESS CENTER APPLICATION
CAMERON EMPLOYEE ID#:
CAMERON EMPLOYEE NAME:
CAMERON DEPARTMENT:
CAMERON EMPLOYEE EMAIL:
University policy allows for an employee’s immediate family members (spouse and/or
dependant children under the age of 18) to have free access to the Fitness Center. The
information provided below will be entered into the system and an ID number will be assigned,
then you will receive an email with the assigned Cameron ID numbers. Family members should
take their ID number to One Stop in the MCC to have an ID card made. Please allow 3 days for
processing.
Application is for my: Spouse
Children
(must be under the age of 18)
FULL NAME
SEX: Male
Female
DATE OF BIRTH:
HOME ADDRESS
HOME PHONE:
SSN:
Employee Signature
Send to:
DATE
Brenda K. Russell
Office: Room 121, Administration Building
Phone: 580-581-2228
Email: brendar@cameron.edu